Abdominal Pain: A Case Presentation

Erik Manninen, CPT, MC

PGY-1 Internal Medicine

History

• CC: Abdominal pain and worsening agitation/mental status x 5 days

• HPI: 85yo WM with diffuse abd. pain for 5 days, increased urinary frequency, and worsening mentation at night.

• PMH: BPH and dementia.• PSH: ?• All: NKDA• Meds: Detrol and ambien started one week PTP.

Exam

• VSSAF

• 8cm diameter suprapubic mass TTP

• Right CVAT

• CV: RRR no m/r/g

• Lungs: CTAB

Differential Diagnosis

• AAA• Mesenteric ischemia• MI• Perforated peptic ulcer• Obstruction• Pancreatitis

• Diverticulitis• Nephrolithiasis• Acute cholecystitis• Appendicitis• Gastroenteritis• Non-ulcer

dyspepsia/PUD• UTI/Pyelonephritis

Labs

• Cr 3.6

• Nl CBC, LFTs

• Blood cx sent

Ancillary

• EKG with NSR

• Renal/bladder US with right hydronephrosis and thin renal cortices consistent with CRD

Intervention

• Foley catheter drained 2500cc dark amber colored urine with gross hematuria near end of void with resolution of suprapubic mass.

• Discontinuance of detrol/ambien.

• Admission and monitoring of electrolytes along with fluid replacement for post-obstructive diuresis.

Outcome

• Pt.’s Cr improved to 1.8

• Pt. Managed by IM with urology consult. – Started on proscar (finasteride) and flomax

(tamsulosin).

• MS changes attributed to sundowning, given haldol on cross-cover.